Prostatectomia

PROSTATECTOMY
Many men older than age 75 have small, slow-growing prostate tumors that cause little harm. However, surgical resection of the portion of the prostate gland encroaching on the urethra may be required to improve urinary flow and relieve acute urinary retention regardless of the patient’s age. Note: Laser prostatectomy is being done in routine practice; however, published datarelative to the efficacy of the procedure are currently insufficient for long-term outcomes.
Transurethral resection of the prostate (TURP): Obstructive prostatic tissue of the medial lobe surrounding the urethra is removed by means of a cystoscope/resectoscope introduced through the urethra.
Suprapubic/open prostatectomy: Indicated for masses exceeding 60 g (2 oz). Obstructing prostatic tissue isremoved through a low midline incision made through the bladder. This approach is preferred if bladder stones are present.
Retropubic prostatectomy: Hypertrophied prostatic tissue mass (located high in the pelvic region) is removed through a low abdominal incision without opening the bladder. This approach may be used if the tumor is limited.
Perineal prostatectomy: Large prostatic masses low inthe pelvic area are removed through an incision between the scrotum and the rectum. This more radical procedure is done for larger tumors/presence of nerve invasion and may result in impotence.
CARE SETTING
Inpatient acute surgical unit.
RELATED CONCERNS
Cancer
Psychosocial aspects of care
Surgical intervention
Patient Assessment Datebase
Refer to CP: Benign Prostatic Hyperplasia (BPH), p.000, for assessment information.
Discharge plan DRG projected mean length of inpatient stay: 3.3–7.1 days
considerations:
Refer to section at end of plan for postdischarge considerations.
NURSING PRIORITIES
1. Maintain homeostasis/hemodynamic stability.
2. Promote comfort.
3. Prevent complications.
4. Provide information about surgical procedure/prognosis, treatment, and rehabilitationneeds.
DISCHARGE GOALS
1. Urinary flow restored/enhanced.
2. Pain relieved/controlled.
3. Complications prevented/minimized.
4. Procedure/prognosis, therapeutic regimen, and rehabilitation needs understood.
5. Plan in place to meet needs after discharge.


NURSING DIAGNOSIS: Urinary Elimination, impairedMay be related toMechanical obstruction: blood clots, edema, trauma, surgicalprocedurePressure and irritation of catheter/balloonLoss of bladder tone due to preoperative overdistension or continued decompressionPossibly evidenced byFrequency, urgency, hesitancy, dysuria, incontinence, retentionBladder fullness; suprapubic discomfortDESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:Urinary Elimination (NOC)Void normal amounts without retention.Demonstrate behaviors to regainbladder/urinary control.|

ACTIONS/INTERVENTIONSUrinary Elimination Management (NIC)IndependentAssess urine output and catheter/drainage system, especially during bladder irrigation.Assist patient to assume normal position to void, e.g., stand, walk to bathroom at frequent intervals after catheter is removed.Record time, amount of voiding, and size of stream after catheter is removed. Note reports ofbladder fullness; inability to void, urgency.Encourage patient to void when urge is noted but not more than every 2–4 hr per protocol.Measure residual volumes via suprapubic catheter, if present, or with Doppler ultrasound.Encourage fluid intake to 3000 mL as tolerated. Limit fluids in the evening, once catheter is removed.Instruct patient in perineal exercises, e.g., tightening buttocks, stoppingand starting urine stream.Advise patient that “dribbling” is to be expected after catheter is removed and should resolve as recuperation progresses.|RATIONALERetention can occur because of edema of the surgical area, blood clots, and bladder spasms.Encourages passage of urine and promotes sense of normality.The catheter is usually removed 2–5 days after surgery, but voiding may continue to be a...